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Workers Comp Affidavit

Workers Comp Affidavit Template for Canada

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Key Requirements PROMPT example:

Workers Comp Affidavit

"I need a Workers Comp Affidavit for a construction company based in Ontario, verifying coverage for a new commercial building project starting March 2025, including declarations for 15 subcontractors."

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Document background
The Workers Comp Affidavit is a crucial document in Canadian business operations, particularly in contexts where proof of workers' compensation compliance is required. This affidavit is commonly requested during bidding processes, contract negotiations, or when engaging with new business partners. It serves as a sworn statement that verifies an organization's adherence to provincial workers' compensation regulations, including current coverage status, premium payment history, and claims record. The document is especially important in high-risk industries or large projects where multiple contractors are involved. The affidavit helps protect all parties by ensuring proper coverage is in place and reducing potential liability risks. It must comply with provincial workers' compensation legislation and requirements for sworn statements under Canadian law.
Suggested Sections

1. Identification of Deponent: Full legal name, position, and business address of the person making the affidavit

2. Business Information: Legal business name, registration details, and principal business address

3. Workers Compensation Coverage Declaration: Statement confirming active workers' compensation coverage, including policy numbers and coverage dates

4. Employee Information: Declaration of number of employees and confirmation that all eligible workers are covered

5. Compliance Statement: Declaration of compliance with all workers' compensation laws and regulations

6. Premium Payment Status: Statement confirming that all premiums and assessments are current and paid in full

7. Claims History Declaration: Statement regarding any recent claims or pending matters

8. Attestation: Formal statement affirming the truth of all declarations made in the affidavit

9. Jurat: Formal closing including date, location, and notary/commissioner details

Optional Sections

1. Subcontractor Declaration: Required when the business uses subcontractors, confirming their workers' compensation coverage

2. Multi-jurisdiction Operations: Required when the business operates in multiple provinces/territories

3. Independent Contractor Status: Required when the deponent needs to confirm their status as an independent contractor

4. Exemption Declaration: Required when claiming any legal exemptions from workers' compensation coverage

5. Project-Specific Information: Required when the affidavit is being prepared for a specific project or contract

Suggested Schedules

1. Schedule A - Certificate of Insurance: Current workers' compensation insurance certificate

2. Schedule B - Premium Payment History: Documentation of premium payments for the past 12 months

3. Schedule C - Claims History Report: Official report of workers' compensation claims history

4. Schedule D - Subcontractor List: List of all subcontractors and their workers' compensation policy information

5. Schedule E - Corporate Organization Chart: Organization chart showing employee structure and coverage requirements

Authors

Alex Denne

Head of Growth (Open Source Law) @ tiktok³ÉÈË°æ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

alex.den.21@genieai.co
Relevant legal definitions

























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Relevant Industries

Construction

Manufacturing

Mining

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Relevant Teams

Human Resources

Legal

Risk Management

Compliance

Health and Safety

Operations

Finance

Administration

Corporate Governance

Insurance

Relevant Roles

Human Resources Manager

Risk Management Director

Compliance Officer

Legal Counsel

Health and Safety Manager

Operations Manager

Project Manager

Contract Administrator

Chief Financial Officer

Insurance Coordinator

Human Resources Director

Workplace Safety Coordinator

Benefits Administrator

Corporate Secretary

General Counsel

Industries







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Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks,  Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination,  Severance Pay, Governing Law, Entire Agreemen

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